Diary of an On Call Radiologist 2
So back by popular demand I decided to write another dairy of an on-call. To change things up a bit I will go through a Saturday day time. On the Saturday we have two registrars on call. One does the 12 hour shift (9 till 9) and the other does the short day shift (9 till 5). Depending on who is with you it can be really nice. I have had some that literally avoid doing any work though! Sooo anyway....
0900 - I've arrived but my colleague has arrived before me. She has taken the hand over from the night reg. Apparently it was busy. Soon after my arrival we get a phone call from the on-call radiology consultant. He's asking if there is anything that we are worried about. Apparently he'll be coming in at about midday to go through everything that has come in so far.
0930 - Not much has happened so far. We had a few CT KUBs coming in. Most of these were normal. Begs the question - What on earth could have caused their '10/10 loin to groin pain'? I hope it's better now:-)
1000 - I was feeling peckish so I had nipped out to get some nibbles. As I was about to leave I notice a 'surgical SHO' that I have had interactions with in the past. He's an absolute trainwreck. I U-turn quickly to get back to the department to help my colleague vet through his drivel.
1050 - Yes, it has taken this long to go through this 'Surgical SHOs' drivel. Ultrasound after ultrasound for absolute nonsense. Having questioned him a bit about what he/his team think is going on he started to go on the defensive, then on the offensive...before going full circle to clueless. He started to namedrop a consultant that my colleague and I haven't heard of. He was adamant that this consultant thinks that the differential for a particular patient is -Cholecystitis/appendicitis/ovarian torsion/cancer. There are not many better ways to say 'I am incompetent'. After a while this 'surgical SHO' states he will be coming back with a few more brain cells (aka bringing his consultant).
1130 - My colleague and I have split the ultrasound scans as they have come in. We have scanned multiple normal abdomens but did see a cholecystitis and a patient with multiple loops of dilated small bowel. That went straight to CT afterwards. We are just waiting on the CT to happen now.
1200 - The CT abdomen has come through. I hate looking for transition points (where the dilated bowel regains normal calibre). The whole thing is very annoying. You follow the loops of bowel around and at some point it appears to loop back on itself and you are back where you started from! It's like playing snakes and ladders. You think you are coming to the end and bam...you've somehow ended up on a ladder back to square one!
1245 - Yes, it has taken me this long to get to the 'bottom' of this bowel obstruction. Truth is, I can't find the transition point. I asked my colleague to take a look and she was not sure either. All I can tell is that it must be a mid to proximal bowel obstruction as the terminal ileum looks normal but the proximal bowel does not. I did my best.
1300 - 'The surgical SHO' has come back and this time with his consultant! It turns out his consultant was a surgical registrar at our trust till about 4 weeks ago! He is now a locum consultant. He is actually very sensible. After much discussion it turns out that he was not aware that the gynaecological team were not contacted yet regarding the ?ovarian torsion. He apologises and says he'll get back to us on some of the unusual requests the 'surgical SHO' has put in. We did manage to discuss better imaging for a few of the patient's he was worried about. All in all it was a productive conversation...isn't nice when we all get along?
1330 - We were feeling hungry. The radiology department assistants and the radiographers have gone for lunch. My colleague and I decide it's time for lunch too since no one is scanning/being brought to the department. I'm looking forward to lunch today. I've packed left overs from last nights movie night. Microwaved pizza for me:-)
1430 - Lunch was great. Turns out we are both big fans of the Great British Sewing Bee! Who knew! Anyway, we have come back and the scans are starting to pile up. There are three already waiting to be looked at. I flick through them to prioritise the ones that need to be acted on soonest. Turns out there is a intracranial haemorrhage - I almost hate to write the lines 'Urgent neurosurgical opinion advised'. I can only imagine the number of phone calls the poor neurosurgical registrar must be getting from around London thanks to that one sentence.
1445 - The radiology consultant turn up in the reporting room. Apparently he was in his office going through the things that had come up through the night and wanted to drop by to make sure things were ok. This radiology consultant is actually someone that was a registrar with me for a while before they were appointed at our trust so we catch a up a bit in general and also ask him his opinion on some of the referrals coming through.
1500 - The 'Surgical SHO' has called me up for a referral. This time it's a RIF pain with raised WCC, CRP in a young boy. He goes through what sounds like an impressive examination (for him) and it sounds like it's appendicitis. I ask him why he required an ultrasound when this is so obvious. He doesn't really know. He then starts to go on the offensive again saying that I am delaying management. I ask him to get his senior to contact me instead. He starts to argue some more. I am really sick of this SHO, but I try to be as nice as possible - after all I don't want to be flagged for 'bullying'.
1630 - I don't hear anything back about that ultrasound for ?appendicitis. My colleague has nipped out and brought back some chocolates for the rest of my shift. After that she leaves early as there are a few scans coming in, but none of these will happen in the next 30 minutes. Yes, she has basically bribed me with chocolates...I am that easy it seems.
1700 - The radiographers have called me up with a list of NG tube CXRs to report. Amazingly we at our trust cannot trust a clinician to know when the NG tube is correctly placed! It has to be reported by a radiologist first! My only worry is...if you can't trust them to know when a tube is in the wrong place...how can you trust them to know when there is consolidation/pneumothorax or any manner of things found on a CXR?! Anyway, it is what it is. I shouldn't bite the hand that feeds me I suppose, and its more plain film numbers for me (radiology registrars have to report at least 2000 x-rays a year...otherwise you get ruined at the ARCP).
1730 - It's gotten a bit lonely now my colleague has gone. It's just me sitting here going through the few thrombolysis scans that have come in. When there is someone with you on these on-calls you can bounce ideas of each other. Even just having a second set of eyes to glance over a problem area is very useful. Anyway, one scan ended up being a large brain tumour causing midline shift and hydrocephalus -' urgent neurosurgical opinion advised'.
1830 - I have been asked to do a portable ultrasound. Apparently the teams have tried to put in a drain in this patient with a large right sided pleural effusion but were unsuccessful. I have a 2 CT abdomens and a CT head to go through still. The medical team state that the patient is really really unwell. Breathless and needing oxygen. They need some help with this drain. I quickly skim though the scans and there is nothing major going on any of them. I run with the portable ultrasound scanner to the wards to find this patient.
1845 - Whilst on my way to the wards I received more referrals for CT heads. One is oldie on warfarin who fell over and the other is a young man who was found on floor unconscious. Can't say no to any of them. They'll hopefully be scanned by the time I am back in the department.
1900 - The pleural effusion is not that big on ultrasound or even on the plain film. Not enough to drain. Upon talking to the patient it turns out they have metastatic breast cancer. I wish the clinical team would have mentioned this previously before asking me to come down to do this ultrasound. Anyway, I call up the medical registrar. We agree on a CTPA as this patient has risk factors.
1930 - I'm back at the department. Thankfully all the scans are done. The abdomen is normal and there was an acute on chronic sub-dural on another - hopefully the last time I recommend a neurosurgical opinion 🙂
2000 - I am waiting for this form for the CTPA but it has not arrived. I call the Medical registrar. No reply, they must be busy. I call up the medical SHO for the wards, who sounded nervous talking to me. I explain the situation. He agrees to put in a form as soon as possible.
2030- The printer finally prints off the form. I doubt the scan will be done before my shift is over but I call up the radiographers to try and get it done as soon as possible.
2130 - I know I am meant to have finished my shift a half hour ago. The night registrar is someone I get along with really well, so we end up talking about our little ones (yes...Donnie is a dad!). Meanwhile that CTPA comes in and it turns out to be large pulmonary embolus!
We trade stories about that 'surgical SHO' and I show him a few of the more interesting scans that have come in through the day. I say the dreaded line 'I hope its a quiet one!' and finally leave work.
The only thing on my mind now is getting back to my own mini Donnie...isn't she cute? 🙂